title: Gasless videoendoscopic implantation of aortobifemoral vascular prostheses via transperitoneal versus extraperitoneal approach in an animal model.
abstract: BACKGROUND
  The goal of this acute experimental study was to demonstrate the practicability and reproducibility of aortobifemoral bifurcational prosthesis implantations via either a transperitoneal or extraperitoneal approach using gasless videoendoscopic instrumentation. The endoscopically sutured end-to-side aortic anastomoses were also examined for fluid tightness.
  
  
  METHODS
  Eighteen of the 20 domestic pigs in this experimental study received aortobifemoral vascular prostheses in a gasless videoendoscopic procedure. Bursting pressures and leakage (ml/min) were compared for the endoscopically sutured aortic end-to-side anastomoses versus those sutured in conventional techniques using 6-h-old porcine aortas and 6-mm prostheses.
  
  
  RESULTS
  The surgical procedures averaged 4 h for the transperitoneal approach (n = 9) and 4.5 h for the extraperitoneal approach (n = 9). However, these times were significantly reduced with increasing routine. Average aortic occlusion times were 1 h for the transperitoneal approach and 1 h 15 min for the extraperitoneal approach; the average iliacofemoral occlusion time ranged from 1 h 45 min with the transperitoneal approach to 1 h 15 min with the extra-peritoneal approach, depending on which side was involved: There were no significant differences in in vitro bursting pressure or leakage amounts between endoscopic and conventionally sutured aortic end-to-side anastomoses.
  
  
  CONCLUSIONS
  Gasless videoendoscopic implantation of aortobifemoral vascular prostheses in animal subjects is both practicable and reproducible using either a transperitoneal or extraperitoneal approach. The extraperitoneal approach has proven advantages over the transperitoneal approach. The in vitro fluid tightness achieved with endoscopically sutured aortic end-to-side anastomoses is comparable to conventionally sutured anastomoses.
authors.affiliation: Department of Surgery, University of Cologne, Köln, Germany.
authors.forename: C J
authors.initials: CJ
authors.lastname: Bruns
authors.forename: B
authors.initials: B
authors.lastname: Wolfgarten
authors.forename: M
authors.initials: M
authors.lastname: Kasper
authors.forename: D
authors.initials: D
authors.lastname: Zenner
authors.forename: M
authors.initials: M
authors.lastname: Walter
authors.forename: B
authors.initials: B
authors.lastname: Manich
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D001012:Aorta, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D002417:Cattle; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D008297:Male; D010537:Peritoneum / Q000601:surgery; D015203:Reproducibility of Results; D013536:Suture Techniques; D013552:Swine; D014741:Video Recording